Most patients with advanced non-small cell lung cancer (NSCLC) have a poor prognosis and receive limited benefit from conventional treatments, especially in later lines of therapy. In recent years, several novel therapies have been approved for second- and third-line treatment of advanced NSCLC. In light of these approvals, it is valuable to understand the uptake of these new treatments in routine clinical practice and their impact on patient care. A systematic literature search was conducted in multiple scientific databases to identify observational cohort studies published between January 2010 and March 2017 that described second- or third-line treatment patterns and clinical outcomes in patients with advanced NSCLC. A qualitative data synthesis was performed because a meta-analysis was not possible due to the heterogeneity of the study populations. A total of 12 different study cohorts in 15 articles were identified. In these cohorts, single-agent chemotherapy was the most commonly administered treatment in both the second- and third-line settings. In the 5 studies that described survival from the time of second-line treatment initiation, median overall survival ranged from 4.6 months (95% CI, 3.8&ndash;5.7) to 12.8 months (95% CI, 10.7&ndash;14.5). There was limited information on the use of biomarker-directed therapy in these patient populations. This systematic literature review offers insights into the adoption of novel therapies into routine clinical practice for second- and third-line treatment of patients with advanced NSCLC. This information provides a valuable real-world context for the impact of recently approved treatments for advanced NSCLC.

pone.0175679.g002: Second-line systemic regimen composition by country and time period.Note: Percentages represent the proportions of patients who received the respective drug regimen out of all patients reported to receive second-line treatments.a Per study investigators, 20% of patients’ second-line regimens were unreported.Germany (2004–2006) and Canada (2005–2009): Patient population consisted of stage IV patients.Europe (2003–2004): Countries included France, Germany, Portugal, Finland, Denmark, the United Kingdom, Sweden, the Netherlands, Israel, Romania, and Peru.Europe (2006–2008): Countries included Finland, Germany, the Netherlands, Portugal, and the United Kingdom.South Korea (2003–2008): All patients had platinum-based first-line therapy.United States (2007–2011): Patient population consisted of metastatic non-squamous NSCLC.United States (2001–2009): Patient population consisted of metastatic squamous NSCLC.NSCLC, non-small cell lung cancer.

Mentions:
Fig 2 and Table 2 describe the distribution of second-line treatment regimens in each of the studies. The proportion of patients receiving second-line therapy among the studies varied depending on how the study cohort was selected and what treatments were included. In studies that followed patients from initial NSCLC diagnosis, the proportion of patients who received second-line treatment ranged from 8% in a population-based Canadian study that did not include oral therapies (epidermal growth factor receptor [EGFR] tyrosine kinase inhibitors [TKIs]) to 53% in a German study at a single institution [20, 24, 25].

pone.0175679.g002: Second-line systemic regimen composition by country and time period.Note: Percentages represent the proportions of patients who received the respective drug regimen out of all patients reported to receive second-line treatments.a Per study investigators, 20% of patients’ second-line regimens were unreported.Germany (2004–2006) and Canada (2005–2009): Patient population consisted of stage IV patients.Europe (2003–2004): Countries included France, Germany, Portugal, Finland, Denmark, the United Kingdom, Sweden, the Netherlands, Israel, Romania, and Peru.Europe (2006–2008): Countries included Finland, Germany, the Netherlands, Portugal, and the United Kingdom.South Korea (2003–2008): All patients had platinum-based first-line therapy.United States (2007–2011): Patient population consisted of metastatic non-squamous NSCLC.United States (2001–2009): Patient population consisted of metastatic squamous NSCLC.NSCLC, non-small cell lung cancer.

Mentions:
Fig 2 and Table 2 describe the distribution of second-line treatment regimens in each of the studies. The proportion of patients receiving second-line therapy among the studies varied depending on how the study cohort was selected and what treatments were included. In studies that followed patients from initial NSCLC diagnosis, the proportion of patients who received second-line treatment ranged from 8% in a population-based Canadian study that did not include oral therapies (epidermal growth factor receptor [EGFR] tyrosine kinase inhibitors [TKIs]) to 53% in a German study at a single institution [20, 24, 25].

Most patients with advanced non-small cell lung cancer (NSCLC) have a poor prognosis and receive limited benefit from conventional treatments, especially in later lines of therapy. In recent years, several novel therapies have been approved for second- and third-line treatment of advanced NSCLC. In light of these approvals, it is valuable to understand the uptake of these new treatments in routine clinical practice and their impact on patient care. A systematic literature search was conducted in multiple scientific databases to identify observational cohort studies published between January 2010 and March 2017 that described second- or third-line treatment patterns and clinical outcomes in patients with advanced NSCLC. A qualitative data synthesis was performed because a meta-analysis was not possible due to the heterogeneity of the study populations. A total of 12 different study cohorts in 15 articles were identified. In these cohorts, single-agent chemotherapy was the most commonly administered treatment in both the second- and third-line settings. In the 5 studies that described survival from the time of second-line treatment initiation, median overall survival ranged from 4.6 months (95% CI, 3.8&ndash;5.7) to 12.8 months (95% CI, 10.7&ndash;14.5). There was limited information on the use of biomarker-directed therapy in these patient populations. This systematic literature review offers insights into the adoption of novel therapies into routine clinical practice for second- and third-line treatment of patients with advanced NSCLC. This information provides a valuable real-world context for the impact of recently approved treatments for advanced NSCLC.